Summer 2012 - Broward County Medical Association

Transcription

Record
the
BROWARD COUNTY MEDICAL ASSOCIATION | S ummer 2012
2012
Commitments for
In the Mix of Changes, What
Should Doctors Keep Their Eye On?
CBP-2679-Healthcare-MM-HR.pdf
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4/17/12
12:04 PM
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the record • spring 2012
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Officers & Board Members
Kutty Chandran, MD, President
Dana Wallace, MD, President Elect
Richard Steinman, MD, Vice President
Sanford Silverman, MD, Secretary/Treasurer
Tony Prieto, MD, Chair, Board of Trustees
Aaron Elkin, MD, Immediate Past President
Co-Presidents, BCMA Alliance
Susan Flaten, RN, Kathy Molinet, ARNP
Diana Moll, MD and Joni Routman, RN
Daniella Botoman, MD
Ely Brand, MD
William Bruno, MD
Greg Burns, PA-C
Lawrence Burns, MD, Assoc.Editor, The Record
Alberto Casaretto, MD
Linda Cox, MD
Nabil El Sanadi, MD
Paul Flaten, MD
Jason Goldman, MD
Mark Grenitz, MD
Edwin Hamilton, MD
David Kenigsberg, MD
Alice Lin, OMS, NSU
Jon Nguyen, OMS,NSU
Arthur Palamara, MD
Payal Patel, OMS, NSU
David Perloff, MD
Ramsey Pevsner, DO
Tim Roedder, OMS, NSU
Alan Routman, MD
Robin Schugar, PA-C
Yvonne Sherrer, MD
Caren Singer, MD
Marc Swerdloff, MD
Victor Toledano, MD
Christopher Wang, OMS, NSU
Alex Youngdahl, OMS, NSU
Ralph Zagha, MD
AMA DELEGATES
Robert Cline, MD
Arthur Palamara, MD
AMA Alternate Delegate
Ronald Giffler, MD
The Record: SUMMER 2012 Issue
Associate Editor’s Page, Lawrence Burns, M.D.
President’s Message, Kutty Chandran, M.D.
EVP’s Message, Cynthia Peterson
The Power of Welcome
Physician Assistants: Working Side by Side with Physicians
Surviving Healthcare: Challenges of Physicians
Medical Care Today
Routine HIV Testing in Clinical Settings
What’s New With the Florida Board of Medicine?
Accessing the Florida PDMP
BCMA Congratulations
Vestigial Knots in the Human Design
BCMA New Members
In Memorium
BCMA 2012 Inauguration Dinner
The Record is the official publication of
Advertisers
the Broward County Medical Association.
Comerica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC
If you are interested in a subscription or
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to advertise in the magazine please
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contact Cynthia Peterson
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cpeterson@bcma.com • 954.714.9772
Gulf Atlantic Legal Defense Insurance Inc. . . . . . . 16
Vincent DeGennaro, MD, President Elect
Florida Medical Association
Cynthia S. Peterson
Executive Vice President
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BROWARD COUNTY MEDICAL ASSOCIATION
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Broward Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
For membership information please
Office Space Available . . . . . . . . . . . . . . . . . . . . . 21
contact Cynthia Peterson
Broad & Cassel . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC
cpeterson@bcma.com • 954.714.9772
Pro Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC
An Editorial Howdee
Lawrence Burns, M.D.
Associate Editor
F
ollowers of The Record know the
magazine has changed over the
years.
More changes are coming. We just
don’t know yet what they’ll be.
Years ago various members of the
BCMA took turns piloting the quarterly
editions of the magazine, while others
contributed articles, usually focusing
on one theme at a time. Then two years
ago a regional publisher took over the
reign, hoping to profit by selling ads within the
journal. That ended this fall, and the task of
putting further editions together has fallen back onto
the laps of BCMA members. Or rather onto their word
processors and digital cameras. Yep, we’re back in
the saddle and aim to fill the pages with facts and
fun—and cover your backs from all the government
agencies, insurance groups, and hospital organizations
that are out to get you.
I was one of the load-sharers from years back, and
was quite pleased when the BCMA board, through
Cynthia Peterson, recently asked me to take the helm
as Associate Editor in steering The Record back under
the group’s control. Hopefully, attending these board
meetings will keep me fresh on what’s important and
current to local docs, after several years of my own
retirement. When I stopped working I had already been
impressed—or depressed—with the geometric growth
of committees and rules and obligation we all faced,
but when I reviewed the last half dozen issues of the
journal I was numb struck by the even grander scale of
local, state, federal and corporate control. It made me
wonder: does anybody enjoy being a physician anymore?
Well, there’s no couch for rehab at The Record. But
getting involved with it may put a little more fun, or at
least self-reassurance, into your career. Readers will
catch the journal evolving over the next few editions as
we figure out what works and what doesn’t, but there
are several features we’ll run with from the start.
And whether the journal will stay on hard print or
go fully electronic is on the board’s table for further
discussion. Your thoughts will be important in making
that decision.
CONTRIBUTIONS. These will include written pieces by
our docs or auxiliary members, including medical
students. Articles may be about any important and
timely medical issue doctors have
to deal with. Case studies will also be
welcome, hopefully aimed at more than
a small part of a single specialty. And
everyone is welcome to take a shot at
writing some-thing warm, witty or just
great-to-read.
Not every written contribution needs
editing, but some may require pencilediting, tightening or other changes to
make the piece read better. Significant
changes will go back to the author for an okay before
publishing. This will be helped greatly by using the
following process: write your contribution and save it
as a document on your computer, then email it as an
attachment to a letter to the BCMA. Doing it this way
allows for editing directly online and will save a lot of
time and work for the staff. Scanning the document
eliminates this possibility, as does faxing pieces to the
office. If this presents a problem for a contribution, get
in touch with us and we’ll come up with another plan.
THE MEDICAL STUDENT/RESIDENT. We share more
and more of our time on the hospital campuses with
medical students and residents. And they have a lot
to say about it, so let’s hear them. We want to dedicate
one page per issue for student/resident-written observations or thoughts, serious or funny, but crafted to
sharing something worthwhile from the perspective of
someone still on the academic ladder. The offer is open
to any student or resident from a Florida institution.
PHOTOS. We live in one of the world’s most
beautiful areas. Let’s show it off. We would like to use
photos taken by docs or associates or students of local
cool things about South Florida, especially in Broward
County. We want to make the covers of The Record
dazzle with stuff of local pride, and keep that as an
ongoing theme. Contributors will be given credit for
bragging rights, but no payment will be available. And
everyone loves those snapshots of doctors at parties or
golf courses or sipping tea at the Great Wall. Whether
the photos should be sent electronically or as hard copy
has not yet been decided. Help us figure that out!
I’M NOT the only doc in the BCMA or the county who’s
interested in helping with The Record. Anyone else who
wants to help either with editing, photo processing, or
writing in various ways, please contact Cynthia, and
we’ll plug you in. Now, back to the future!
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Commitments for 2012
Kutty Chandran, M.D.
President
D
uring my tenure
as
your
new
President,
and
beyond, it is my intention to honor the
mission and the purpose
of this organization as
we work together to
strengthen the sense of
community throughout
Broward County and
its medical programs. I
want to take this
opportunity to thank the
Board of Trustees, Board
of Directors, and the
members of the Broward County Medical Association
for electing me as your 85th President of the BCMA. It
is an honor and privilege to serve you. Thank you.
As we all know, the world has gotten faster and
more complicated, and as a result, each one of us
faces new challenges on a daily basis. Processes
and demands that were once a natural part of
every day life seem to have become more and more
daunting. Now, more than ever, we all need a “go
to place,” one that serves as a context and a nexus
for all phases of the medical community, to share
situations, solutions and other forms of information
that will ultimately support all of us in being more
effective medical professionals.
A year ago, while I was away for a weekend, a
patient of mine for 20 years was hospitalized, and
was assigned to a hospitalist. The following Monday,
when I visited her, I got the following message:
“Doctor, after all these years as your patient, when
I really needed you, you were not here.” This, my
friends, is the way the system has evolved. But is it
what our patients really want?
It’s tough to create change if we’re forced to do
it alone. As members of the BCMA, functioning as
a core group of committed physicians, we can work
together to avoid this sort of patient distress and
miscommunication. We can help our patients all
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the more, while balancing our professional and
private lives.
Let me take a brief moment to describe the history
of organized medicine. When the medical societies
were formed in the in the late 1800s and early 1900s,
their function was to educate physicians, improve the
quality of their practices, and regulate the profession
with ethics and professionalism. The societies were not
involved in the financial aspect of medical practice,
which was left to free market forces. The medical
societies even had the power to grant licenses,
thus forcing medical men of those days to belong
to those groups. The first medical school was
created by the effort of a medical society in 1765 in
Philadelphia. As the medical societies—for example,
the Mayo Clinic—began to create the best medical
education and lead the research in medical cures, the
Government stepped in and started to chip away at
the power of organized medicine, using tools such
as Antitrust Laws. The result was the fragmentation
of organized medicine. Multiple specialty groups and
sub-specialty societies were formed, by educational
institutions and related organizations, and included
employed physician groups, varying certifying boards,
and even ethnic medical societies. It was a time
when most medical professionals were members of
organized medicine. Today, only about one third of
our colleagues belong to a national association.
Consider this contrast: Most attorneys, if not all,
belong to their respective Bar Associations. We all
have heard the maxim, “Strength in Numbers.” It
is the same with us. It is in the best interest of our
profession and our patients, that we reclaim that
sense of community, and use those connections to
strengthen OUR status.
Dr. Nathan Laufer, of the Maricopa Medical Society
in Arizona, published an article titled, “Organized
Medicine: why it Matters.” In Part One of the article,
he states, “ If we have several wishes of our medical
practices these are probably what they look like: we
would like to continue to practice independently as
small businesses, be fairly compensated for our work
and years in school, have influence with legislators
regarding healthcare issues, be in charge of quality
care issues, maintain patient choice regarding
doctors and hospitals, get rid of the roadblocks
that are preventing collections from payers and
most importantly to be allowed to organize and do
collective bargaining (if needed Federal Trade antitrust
exemption).” And I agree with that statement. By
maintaining a strong and viable medical association,
that vision is not just possible, it’s actually probable!
The medical profession and all its attendant satellite
professions and industries have evolved light years in
the past several generations. It’s hard to believe that
back in the 1800’s, medical men were laypersons
that did not enjoy the prestige and status that we
enjoy today. Thanks to the efforts made to organize
our “industry,” it is universally considered a noble
profession throughout the world.
There are so many complicated and stress-inducing
Issues facing today’s practicing physician:
• L ow reimbursement for services with rates
fixed by the government,
• L oss of physician autonomy and medical
staff issues,
• Cumbersome new Medicare enrollment issues,
• E scalating of costs in all areas of practice,
from administration to insurance, legal fees,
technical support fees, etc.
• Electronic Medical Records issues,
It also seems as if rules and regulations are
changing more frequently than ever, and it’s becoming
increasingly difficult to maintain a sense of being
informed. Sometimes I think, “There’s only so many
hours in the day. What’s more important, tending to
the health and well being of my patients, or making
sure mountains of paperwork are completed?” Well,
we know what the answer should be.
As the President of this fine organization, I will
work with state and national associations to address
some of these issues. But I need help from YOU,
the members of this organization. We need active
participation. We need to grow our ranks and bring
more members to the house of medicine. As the
organization grows, so will the benefits of belonging.
Remember the expression, “Critical Mass.” As we
grow, so will our influence and voice. The BCMA can
be a force not only in this community, but throughout
Florida, and even in the rest of the country!
Never lose sight of who you are and how you’ve
chosen to share your life, your knowledge and your
compassion. The Physician still has the power… The
power of the pen or the computer keyboard. As
Physicians, you give people life, you tend to people
through illness, and you sign the certificates of both
birth and death. Every day we make hundreds of
decisions that have indelible impact on the people
trusted to our care. We took the Hippocratic oath, and
we pledged our lives to care for others. In this day and
age, we have choices. We can either accept conditions
as they are, or we can choose to come together to
strengthen our collective voice and have a positive
impact on our practices and our patients. We have the
ability to prolong the longevity of our society, and we
have the ability to rally for positive change.
Positive change can happen in the medical
professions through the collective strength and
participation of all of you: My Colleagues. Remember
the words of Mahatma Ghandi. He said, “Be the change
you want to see in the world.” Change only comes if
we choose to proceed to change. Think what men with
commitment can do: Gandhi winning independence
from the British Empire; Martin Luther King catalyzing
critical social change, George Washington leading
and then winning a revolutionary war. We may not
have that single-minded force, but collectively we
can bring a change to the medical world for the
common good.
As you see, I’ve “stepped up to the plate,” and I
am proud to see all of you as my teammates, united
in promoting the health, stability and positive growth
of the noble profession we’ve all chosen as our life’s
work. I invite all of you to join me in being the change
we want to see, and I look forward to a year full of
positive and impactful work for our community. I
welcome all of you to participate!
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FOR THE RECORD…
Cynthia S. Peterson, Executive Vice President
Just for the Record, on August 1, 2012,
I will celebrate with joy my 22 years as
your Executive Vice President. That means
that I have worked for 22 Presidents and
22 Boards of Directors. There have been
many changes over the years, some good,
some bad for organized medicine.
When I arrived, many doctors were not even using fax machines.
Today, we are trying to wean doctors from fax machines to email. This
has taken several years and we are still not 100% there. BCMA was
one of the first medical associations in the state to have a web site,
thanks to a past president, Dr. Barry Tepperman, who later moved
out of the state. The web site went through reconstruction during Dr.
Nigel Spier’s presidency in 2007 and now is going through another.
Just bear with us for you soon can pay your dues online. If you are
trying to share your office, sell your office, find a new partner, this can
be posted on the web. www.BCMA.com. Everything takes time and
money. So, thank you for continuing to pay your dues and for your
continued support of the BCMA. A patient can go to the web site
and see the Physician Directory. Our plan is; if you have a web site to
place this under your name so that the patient can then click on the
link to your web site.
We will be sending out a note soon to see who has a web site. If
you do not have a web site, we will give you the information for the
company we use for the BCMA web site, Poweri.
I know that times have been difficult the past 4 years. Your
reimbursements from Medicare, Medicaid, and managed care usually
never arrive on time. Sometimes not at all. If you are experiencing
a problem being paid, please let me know. The BCMA Board has
developed a relationship with many of the Medical Directors of the
managed care companies as a direct contact. It really helps, but you
have to let us know if you are having a problem.
In the past few years, it is as if a hurricane has blown through
the healthcare system and turned things upside down. So many
changes occurring at one time. Is it possible for physicians and their
patients to understand all the changes. Some are good for patients.
Some are good for physicians. However, most of the changes have
placed a huge burden on the practice of medicine. Members are
still having problems with PECOS, E-Prescribing, and transitioning
into EHR. What will be next? Well, the BCMA will be here looking
out for you as we go on the journey with the Patient Protection and
Affordable Care Act (PPACA), CINs, ACOs, PHOs, Tweets, Texts, Apps,
and Facebook. Embrace your organization, get involved, or is your
head in the CLOUDS?
The Broward County Medical Association and Broward County
Pediatric Society were part of the federal lawsuit, Wollschlaeger vs
Farmer, challenging a new Florida law, prohibiting physicians from
asking their patients questions, such as do you own a gun.
U. S. District Judge Marcia Cooke held, “through this law,
inserts itself into the doctor-patient relationship, prohibiting and
burdening speech necessary to the proper practice of preventive
medicine.” Special thanks to Thomas R. Julin, Esq, Chair of the First
Amendment Litigation group of the international law firm Hunton &
Williams, LLP, Miami.
Don’t forget to call 954.714.9772 or email cpeterson@bcma.com if
you need assistance. That is a Value Added Membership Benefit. We
are here for you!
Upcoming events:
More Social Networking Events at BoneFish Grill, watch for
the dates.
Saturday, September 15 – “Time for Tough Choices at Your
Practice: Get a Grip on Your Future” 9:00 am – 3:00 p.m.,
Sheraton Hotel, I-95 & Griffin Road
Wednesday, October 17, 6:30 pm-8:30 pm, Women Physicians
Dinner Meeting, Tower Club, Ft. Lauderdale
Saturday, November 3, BCMA Annual Dinner, Hyatt Regency
Pier 66, Dr. Dana Wallace will be installed as President
(watch your email and fax for these notices)
In the Fall, BCMA will begin a series of meetings on Coding
and ICD-10 with Jean Acevedo as the expert speaker.
The Broward County Medical Association Foundation
and Broward County Health Department were approved for a
grant from the Gragg Allman Hepatitis C Community Education
Grant Fund. The purpose of the grant is to increase the number of
providers in Broward County who care for people at risk for viral
hepatitis. The grant was approved by the National Viral Hepatitis
Roundtable, (NVHR). When Mr. Allman was in concert in Fort
Lauderdale, the group met with him to tank him for the grant.
L to R: Aaron Elkin, MD, Immediate Past President, BCMA; Paula Thaqi, MD,
MPH, Director Broward County Health Department; Gregg Allman; Cynthia
Peterson, EVP, BCMA
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The Power of Welcome…Hospitality Beyond Property Borders
Roberta K. Nedry
President and Founder, Hospitality Excellence, Inc.
W
hat makes us feel welcome,
comfortable, appreciated in any environment? What kinds of emotions are
triggered when we experience a welcoming
feeling—and when we don’t? How do service
providers instill a spirit of welcome in their teams
and create a warm sense of belonging the
moment their patients arrive? And how can the
power of welcome move beyond borders and
reach out to patients before they even set foot in
the office or on the premises?
Recently, I was in a doctor’s office and was overwhelmed by
how welcome I felt and how comfortable the staff made me feel.
Having felt quite the opposite, unwelcome and uncomfortable,
in many doctor offices, I was actually stunned by this experience.
What made this team at the South Florida Spine Clinic so different
is that from the moment I opened the door, everyone I met, from
the receptionist to the nurse and the doctor, greeted me warmly
by name and with direct eye contact, and explained what would
happen next. I felt special even though I was probably one of over
100 patients that day. I noticed that the doctor in charge, Jeffrey
Cantor, was very interactive with his staff, greeted and laughed with
them, and kept a level of positive energy going at all times, even
with a demanding schedule. Dr. Cantor made his staff feel special,
too, and that impacted the way they treated each patient.
In any service or healthcare environment, the spirit of welcome
is so important in creating a strong foundation for the patient
experience. Every employee can add to the “welcoming”
experience for patients!
A welcome goes beyond words. It creates a feeling of caring
and gives a sense of reassurance. A sincere welcome pulls
patients in to the care environment they have chosen, and makes
them confident they made a good choice.
Written or telephone communications to confirm appointments
can begin the welcoming process. Adding a welcoming statement
to the correspondence helps establish a warm feeling for each
pending visit. The patient feels the doctor and his staff all care.
Children offer all sorts of opportunities for unique welcome
strategies. I always appreciate an office that acknowledges and
welcomes my 8 year old son at the same time they welcome
me. When parents have no other care/babysitter options, they
may have to bring children with them in order to make their
appointment. A small gift of something, like tic tac toe sheets
or other games, or even a treat can help occupy the child’s time
while parents focus on their own health issues.
On the other hand, an unwelcome feeling is very easy to
create as well. Looking down while speaking, no introduction
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or use of names, rushed and robotic gestures,
efficient yet discourteous service – all of these
can dismiss any hope of a welcoming feeling.
When a feeling of welcome is not there,
it makes patients feel uncomfortable and
question their healthcare or business choice.
Patients become less inclined to come back to
that office, or refer others to the practice.
There are many ways to use the power of
welcome as a business strategy. As a starter,
keep the following tips in mind:
• R
ecognize how to make patients feel welcome. Direct
eye contact, smiles, and sincere words at each point of
contact will generate positive emotional responses.
• Introduce yourself. By giving your name you extend your
welcome, and it makes patients feel relaxed. This includes
each person and point of contact in the patient experience
• K
eep checking on patients and evaluate if they seem to
feel welcome or if they appear uptight or uncomfortable.
• S trategize on ways to reach out and invite patients
to feel welcome before they set foot on the premises.
• C
onsider extra touches to build on a feeling of welcome.
Brainstorm for ideas with managers and their teams,
then involve them in the process.
• E nsure that employees feel welcome in their own work
space, and welcome them each day. Post signs in break
rooms and around the property and make sure that all
staff meetings begin with a sense of welcome.
Creative use of the spirit and power of welcome can help both
patients and employees feel more comfortable at those stressful
and anxious moments that can occur in any medical practice.
Welcome a welcoming strategy into each patient experience,
and then welcome the referrals, repeat business, and additional
income that will follow!
Roberta Nedry is President of Hospitality Excellence, Inc., leaders in
guest experience management. Ms. Nedry has developed a unique
3D Servicesm methodology to take guest, customer and patient
service to the next level. Her firm focuses on guest, customer and
client service, the concierge profession and service excellence training
for management and frontline employees in all industries. To learn
more about Hospitality Excellence programs, exceptional service and
the new 3D Servicesm Online training program - a New Dimension in
Service Excellence, visit www.hospitalityexcellence.com
Ms. Nedry can be contacted at 877.436.3307 or roberta@
hospitalityexcellence.com.
Physician Assistants: Working Side-by-Side with
Physicians and State of Florida Healthcare Organizations
Gregory L. Burns, MMS, PA-C
Associate Director of Clinical Education-Barry University PA Program
Board of Director-Broward County Medical Association
Immediate Past President-Florida Academy of Physician Assistants
W
hen I graduated from
Physician Assistant School
at
Nova
Southeastern
University-Ft. Lauderdale Campus, I
never imagined myself becoming a
leader in the only State-recognized
PA Organization: Florida Academy
of Physician Assistants (FAPA). Don’t
get me wrong, I had aspirations to
become some sort of leader after Nova
but I did not know what would come out of it. After
graduation and studying for my PA Board Exam, my
brain turned into tapioca pudding. However, I did
have a wonderful mentor in PA school that convinced
me to get more involved in the PA Profession sooner
rather than later. That mentor was FAPA Past
President Michael Funk, PA-C. Through his guidance
and expertise, he educated me to become a
Regional Director leader within in FAPA and then led
me to be voted in as the President of FAPA in 2010.
Michael also led me to become a member of
the Board of Directors of the Broward County
Medical Association (BCMA) in 2008. Since then, I
have had the pleasure of attending BCMA Board of
Director Meetings working with Physicians and with
Executive Vice President, Cynthia Peterson. Thanks
to the help of BCMA, PAs can now be members
of other County Medical Associations such as the
Palm Beach Medical Society (PBMS), Dade County
Medical Association (DCMA), and Pinellas County
Medical Association (PCMA). It is our hope to
include more Florida counties in the near future.
Over the past five years, FAPA has progressively
strengthened its alliances with not only county
medical associations, but also with state-wide
organizations such as the Florida Medical
Association (FMA), Florida Osteopathic Medical
Association (FOMA), and Florida Academy of
Family Physicians (FAFP). Together, we have
worked with these groups to lobby for the passing
of a law requiring a Central Monitoring system
for controlled substance prescription acquisition
implemented last year by the State of Florida.
With the strong support from
these groups, FAPA has been
able to pass a Physician Assistant
Bill in the State of Florida since
Michael Funk was President in
2007. In 2009, the elimination of
parenteral and antipsychotic medications from the list of medications
that PAs cannot prescribe was finally
put into place by rule. Also, FAPA
was instrumental in getting legislation passed that
deleted the mandatory co-signature of medical
records of PAs. Physicians now determine what is
best for their practice in regards to co-signature of
medical records.
In 2010, FAPA helped passed a bill that
eradicated the rule of having to wait three months
in order to write for any prescriptions under
physician supervision upon PA employment or
switching medical specialties.
In March 2012, FAPA passed one of the
only scope-of-practice, or rather, streamlining of
licensure, bills to be approved this year. The
bill deletes a duplicative second license that is
currently required of a Physician Assistant to gain
prescribing authority – a requirement shared by
no other prescribing practitioner. The bill further
deletes a requirement for an unnecessary threehour prescribing course to be taken every two
years. The bill stipulates that the Florida Board of
Medicine may establish rules relating to the cost
of a prescriber number, which may be the same
as the PA license number. This bill should put
Physician Assistants on more equal footing with
other prescribing practitioners.
As an organization, FAPA will continue to
strengthen our alliances with these important
healthcare organizations and perhaps, work jointly
together on future projects or bills. We feel that
the Physician-PA Team Approach to Medicine will
be the Key to providing exceptional healthcare to
the patients of the State of Florida in the near and
distant future.
9
Surviving Healthcare: Challenges of Physicians
Robert Cline, M.D., Past President
Florida Medical Association &
Broward County Medical Association
A
t first glance, the title of this article suggests
that we are going to provide you with “pearls
of wisdom” regarding practice management
and organizational skills to help build and maintain
a successful medical practice in today’s hostile
environment. There are abundant books and medical
business journal articles that offer excellent advice
about office management, record keeping and contract
negotiations with hospitals and third party payers.
Aside from this, there are, however three attitudes and
habits which can have a tremendous influence on your
survival and, in many cases, are more important than the
business management of your practice. If you do not pay attention to these three items
you may not have much business to manage!
The first and probably the most important of these is COMMUNICATION,
communication with patients, staff, colleagues, and business consultants. Patients love a
doctor who communicates in a clear and timely fashion and listens to their problems and
concerns. By the same token, your colleagues want you to communicate regularly about
the patients you share. You must take time from your busy office schedule to provide
verbal and written reports about your plans for their patients. It is also known that many
malpractice cases result from inadequate or improper communication by physicians
and staff. Many burdensome lawsuits can be avoided by simple, timely, and accurate
communication. In addition, many Board of Medicine cases arise from communication
errors or deficiencies and result in lost time or worse dealing with these issues.
Just as important is number two: AVAILABILITY. There is a recent emphasis in
medical training programs to provide abundant time for rest and study. But this can
rob the trainee of learning how do deal with continuity of care: they’re unavailable
when their patients need them most. It’s certainly a terrible habit when embarking
on a demanding practice, and it leaves future doctors unprepared for the availability
their hospitals and patients will require. Doctors can’t just relegate their obligations
to other staff and extenders when they are the ones who are needed. Furthermore,
availability should not be based on reimbursement, but on the specific need at hand
at the moment. We must always reach out to a colleague or hospital when we are
needed. Be available and your practice will be rewarded. It is tragic that so many of
us have forgotten the Oath we took upon graduation from medical school.
Finally, AFFABILITY is an invaluable, somewhat intangible trait that must be cultivated
to promote a successful medical practice in today’s environment. When our lives
seem filled with disgruntled patients, unhappy staff, and unreasonable payers and
regulations, it comes as a real delight for everyone to work with an affable, friendly,
polite and caring physician. Your attitude and social behavior can put you at the top of
other doctors’ lists when considering a referral. At the same time, your patients will
receive optimal care when nurses see you as a considerate and affable physician.
Remember, a little kindness goes a long way.
These three simple habits and behaviors, COMMUNICATION, AVAILABILITY, and
AFFABILITY are vital for your survival in the disturbing economic and professional times
we are facing. Cultivate these skills and you will find success and peace with your
patients, your staff, your hospital, and most importantly—with yourself.
10
Medical Care Today
Octavio E. Prieto, M.D., Chair
BCMA Board of Trustees
A
s I was thinking about
what to write for the The
Record, I was going over
all the changes in medicine. In
my specialty of primary care,
government-based
insurances,
third party insurance companies,
slow payers, etc., are destroying
offices. A few years back I had
one-stop medicine in my office. I
provided lab work, x-rays, EKG’s,
ultrasounds and CT scans. I was saving the
insurance companies thousands of dollars by not
sending patients to the hospital for diagnostic
testing or emergency rooms. There is not a doctor
today who still has a lab set up in his office or a CT
machine. I still provide x-rays, EKG’s, ultrasounds,
and Holter monitors.
I like comparing Primary Care with other
professions. If we were carpenters building a
house, wouldn’t we require the proper tools?
We would need hammers, nails, and saws to
get the job done. Primary Care physicians need
tools of their own, to make timely diagnoses in
our offices at the time of service. Doctors should
not have to send a patient to a lab to have blood
drawn and then have to wait days for results. But
today we’ve become referral doctors: If a patient
presents with chest pain, we refer them to the
ER; if a patient needs blood work done, we refer
him to a lab. In both cases, we have to wait for
results. The main factor, though, is that what
would probably cost less than $200 in an office
setting will now cost thousands if done in the
emergency room.
Let me demonstrate how things have turned
upside down using the stories of a couple of
my own patients. Not long ago, an overweight
patient presented with leg pain, and I felt he
needed an ultrasound of the leg to rule out DVT.
My ultrasound technician is no longer available
every day, unlike in the recent
past, but even if he had been,
the patient’s insurance company
did not allow this test to be done
in a doctor’s office. I had to refer
him to the insurance company’s
diagnostic center. Being that it was
a Friday, the test was rescheduled
for Monday, when the DVT
was found. After receiving this
information, I referred him to
the emergency room immediately. By the time
the patient got there later that day, he already
had bilateral pulmonary emboli. However, the
story doesn’t end there. Only two days later the
physician advisor from the insurance company
began pressing me as to why the patient was
still in an ICU? That, when the patient was
still on a heparin drip! Another example is a
patient I saw at 3 PM in my office with positive
right lower quadrant pain. Not having labs in
my office to check his WBC and other tests, I
had to refer him to the ER. Around 8:30 PM,
as I was in a doctors’ meeting, I suddenly
realized I had not heard anything from the
ER about this patient. Calling the hospital, I
found out he was still getting worked up,
was in line for a CT of the abdomen. Good
thing he did not perforate as he had a
positive appendix. In the “old days,” having
had the tests available in my office, he probably
would have been in surgery by 4 PM.That,
friends, would have been better medical care.
Doctors, we NEED to unite!
Large groups today are getting much better
treatment than solo practices, with better
contracts and fewer denials. There IS strength in
numbers.
Join us today at the Broward County Medical
Association, attend our meetings, speak your
mind and maybe we will all survive.
11
Routine HIV Testing in Clinical Settings
Paula Thaqi, MD, MPH
Director, Broward County Health Department
G. Stephen Bowen, MD, MPH
Medical Epidemiologist, Broward County Health Department
Introduction
Highly Active Antiretroviral Therapy
(HAART) has transformed treatment
of HIV infection by HIV specialist
physicians, has substantially reduced
AIDS-related mortality and has
made this a chronic manageable
medical condition. People who are
diagnosed early in their disease
course can be treated before their
immune systems deteriorate and
before opportunistic infections such
as tuberculosis and HIV-related
malignancies occur. Undiagnosed
recently infected people have high
viral loads and may often transmit
HIV to others. People with HIV who
are actively engaged in care, fill their
prescriptions on time, take their
medications as prescribed, have their
Population-based HIV Testing
1. National Health Interview Survey (NHIS) and National
Health and Nutrition Examination Survey (NHANES)
data indicate that less than 50% of adults age 18-64
and 34% of 18-24 year olds have ever been tested for
HIV. More than 20% of infected people are unaware; for
high risk men the proportion unaware is 45%. Unaware
people are more likely to transmit HIV (Ref: Marks et al,
AIDS 2006; 20, 1447-50).
2. Each year since 2004 Broward County has the highest or
2nd highest newly diagnosed AIDS rates among United
States urban areas. Since 2008 this is also true for new
HIV case rates. In Broward County, it is estimated that
more than 16,000 or approximately 1 in 100 people 18
years of age or older are diagnosed and living with HIV/
AIDS and 3000+ people are infected, but don’t know.
Most adults visit one or more health care facilities,
offices or clinics for years without being tested before
being diagnosed. Most will have blood drawn for other
reasons, but HIV testing was not done. Most patients
will agree to be tested if their doctor recommends it.
12
viral loads and CD4 counts monitored and, as a result, have
undetectable viral loads are much less likely than are untreated
people with HIV to transmit HIV to their babies perinatally or
to their sex partners. (Ref: Cohen, MS et al; Prevention of HIV1 Infection with Early Antiretroviral Therapy; New Eng J Med:
2011, 365 (6) 493-505). We now have the tools in hand to
substantially reduce the epidemic of HIV/AIDS because early
diagnosis and treatment is an important aspect of prevention.
This is dependent on people getting tested and knowing their
HIV status.
The Centers for Disease Control and Prevention (CDC),
after consultation with diverse medical specialty
organizations and representatives from a large number
of clinical settings, since 2006 recommends HIV testing to
be a routine part of medical care in most medical settings
including private practices, clinics, hospital emergency
departments and for inpatients in hospitals.
A detailed rationale is found in Branson, BM et al; Revised
Recommendations for HIV Testing of Adults, Adolescents
and Pregnant Women in Health Care Settings, MMWR, Sept.
22, 2006 55/RR14; 1-17. CDC recommends that adolescents
and adults 13-64 years of be tested and that people at high
risk such as men who have sex with men, spouses or sex
partners of HIV positive people and injection drug users be
tested at least annually. Many health systems including two
in south Florida, 6 hospitals in Washington DC, and diverse
systems in Oakland, California, New York City, Los Angeles,
San Francisco, Massachusetts, and Denver, Colorado have
demonstrated that routine HIV Testing is acceptable to
patients and health practitioners and is feasible to implement
during normal operations.
The recommendations for routine HIV testing are
consistent with recognized criteria for screening programs:
a) HIV is a serious disorder that can be diagnosed before
clinical symptoms begin; b) HIV can be detected by reliable,
inexpensive and non-invasive patient-acceptable tests; c)
Early treatment preserves health and prolongs life; d) Costs
are reasonable in relation to benefits.
Conclusion: Broward County Health Department and Broward
County Medical Association urge medical practitioners to make
routine HIV testing for patients age 13-64 including testing
new patients at their initial or second medical visit to be a
standard of care in Broward County.
13
What’s New with the
Florida Board
of Medicine:
I
By Crystal A. Sanford
n 2011, the Florida Board of Medicine underwent
many changes. One of those changes was a
complete overhaul of our website based on
comments received from our licensees as well
as the general public. This article will provide
you with an overview of the website so you can find
information when you need it.
The web address for the Division of Medical Quality
Assurance (MQA) is www.doh.state.fl.us/mqa. This
site is the overview site applicable to all health
care providers and from this site you can access
many things:
 Renew your license
 Update your Practitioner Profile
 Update your address
D
esignated yourself as a controlled
substance prescriber
C
reate a relationship between yourself
and a pain-management clinic
 Request a duplicate license
 Request a license verification
A
ccess information on counter-proof
prescription pad and approved vendor list
 New changes in law
 And much more…
Coming soon - The Board of Medicine’s licensure
applications will soon be online. This will allow
applicants to complete the application and submit
the fee with the application online.
14
The Board of Medicine web site can be accessed from
the MQA site or by typing in the web address which
is www.doh.state.fl.us/mqa/medical. To access it
from the MQA web site, simply click on Health Care
Professions and select Medicine.
Everything on this site is related to physicians.
Below is a list of the categories available on this
site and the types of documents that can be found
under each category:
Apply for License
As mentioned earlier, this is where an applicant
would go to access online applications. This section
also contains information on licensure requirements,
fees and other forms.
Board Meeting Information
This section includes meeting dates and locations,
the actual agenda materials, minutes and audio of
the meetings. You can also find information on the
Board Members in this section.
Contact Information
This section provides the Board of Medicine address,
telephone number, facsimile and email address.
Continuing Education
This section provides the continuing medical
education requirements necessary for renewal of
your license.
Petitions for Declaratory Statements
This section is a link to a searchable database of
Final Orders on Petitions for Declaratory Statement.
A Petition for Declaratory Statement is a legal
mechanism for physicians to request clarification
Introducing Changes to the Board’s Website
from the Board on a particular law as that law relates
to that particular physician’s circumstances.
Professionals Resource Network (PRN)
This section provides contact and other information
for PRN, Florida’s approved impairment program.
Profession Updates
This section contains alerts from the Department of
Health, Board of Medicine and DEA. Also available
in this section are the current and older versions
of the Messages from the Chair and the Board’s
Annual Reports.
Registration/Inspection
This section has links to the Office Surgery
Registration and Inspection Program and the PainManagement Registration and Inspection Program.
All information related to these two programs can
be found here.
Renewal
This section provides renewal dates. You can also
link to MQA Services where you renew your license.
There is also information about renewing through
the mail instead of online. Remember that renewing
online is faster and you can print confirmation of
your renewal.
Laws and Rules
This section of the web site lists all pertinent laws
and rules as well as links to access them. There are a
few specific laws highlighted in this section as well.
responsibility form; relinquishment forms; address
change forms; dispensing practitioner registration
forms; and many more. All forms can be completed
online, printed and mailed to the Board Office.
A great option, for physicians to receive information
as it occurs, is to join our Interested Parties List
(Mailman). Emails will be sent directly to you with
information we are posting on our web site. By
using this tool, your email address is not readily
available for public viewing on your Practitioner
Profile. You can join the Mailman by clicking on
its link on the Medicine web page or by
going to http://www.doh.state.fl.us/mqa/medical/
me_mailman.html.
As always, if you cannot find the information you are
looking for on our web site, we will be glad to assist
you. You can send us an email at MQA_Medicine@
doh.state.fl.us and we will respond within 24 hours.
Ms. Sanford is currently
a Program Operations
Administrator in the
Board of Medicine and
has worked in the
Board for over 20 years.
Forms/Information
This section houses all of our forms except
applications for licensure. This includes the financial
the record • spring
the record
2012
15
Accessing the Florida Prescription Drug Monitoring Program
T
he Florida Prescription Drug
Monitoring program (PDMP)
was signed into law in June
of 2009 and went live online in
mid-October. The website is simple to
use and the information is displayed
in an easy to read format. A query
into the database is not cumbersome
and only takes a few seconds.
By law, dispensing providers
must submit to the database within seven days of dispensing.
In reality, the data obtained from the PDMP is variable. Based
on my personal experience, reporting from within seven days
to no reporting at all is occurring.
The information provided by the PDMP gives physicians and
pharmacists valuable insight into patients’ prescription activity.
Physicians who prescribe controlled substances to manage
chronic pain should utilize risk management strategies to
mitigate adverse outcomes to patients and ourselves. I have
found the PDMP fills a void in my risk management toolbox.
If you have not registered for the Florida PDMP, it is relatively
easy. The following website allows licensed Florida physicians
to register in the database: http://www.hidinc.com/flpdmp
Click on registration for practitioners/pharmacists and
follow the directions. Use your DOH ID and password that
come with your license renewal. Once you have been given
access, you will be asked to create a unique username and
password to access the website.
A query will require the patient’s name, gender and DOB.
You can obtain their entire controlled prescription history in
the state for at least the past 3 months.
Sanford M. Silverman, MD,
President-Elect Florida Society of Interventional Pain Physicians
Secretary, BCMA
Some Pathways are Treacherous.
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16
Steven D. Wexner, M.D. has been elected an active fellow of the
American Surgical Association, making him one of just 460 in the
nation and the only one in Broward County. Dr. Wexner is currently
President of the American Society of Colorectal Surgeons and is the
immediate past president of the American Board of colon and Rectal
Surgeons. He is also serving his first three-year term as a representative on the prestigious American College of Surgeons‘ Commission
on Cancer. Dr. Wexner is Chairman of the department of Colorectal
Surgery, Chief Academic Office and emeritus Chief of Staff at Cleveland Clinic Florida. We are pleased to acknowledge that Dr. Wexner
has been an active member of the BCMA for 24 years.
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design, Brittania Carnevali with
Professor Linda Weeks, MFA,
Advertising and Graphic
Design, The Art Institute
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17
Vestigial Knots
IN THE
HUMAN DESIGN
One medical student’s perspective on our quirky heritage
…what a hodge-podge design the whole affair is:
20,000 single genes coding for a menagerie of
organs, duct-taped together, often inefficiently,
by connective tissue…
I
By Will Jaffee
n the first two years of medical school, students
are buried in the basics of anatomy, physiology,
biochemistry, and the like. “Buried” even seems
an understatement; “having one’s mind blown
open while fitting in thousands of new terms,
3D structures, and empty French presses” is
a bit closer to the truth. Nonetheless, when we get
time to reflect on the knowledge we’ve gained thus
far, and are able to take even a five foot view of the
whole body, rather than five nanometer (in bioche
mistry) or five centimeter views (in
anatomy lab), many of us reach the
same hackneyed conclusion. We then
sum it up at the Thanksgiving dinner
table to our curious family: “Uh,
yeah, the body is really beautiful and
complicated. It’s amazing how well
designed it is!”
While a cursory viewing of any
mammal would lead one to think this,
the devil is in the details. As such, I’ve
been thinking about what a hodgepodge design the whole affair is:
20,000 single genes coding for a menagerie of organs,
duct-taped together, often inefficiently, by connective
tissue. Things go wrong all over the place, and we’ve
got a police squad (immune system) that’s often
ill-funded (as in 70+ immunodeficiencies), or overfunded (as in the lymphomas/leukemias). Sometimes
it’s just far too aggressive (as in the hypersensitivity
disorders, e.g. allergies to shellfish, which deprive
their hosts the insurmountable pleasure of ingesting
the tail of a Maine lobster).
Further,
our
evolutionary
heritage
shines
through in designs that were quite helpful for, say, a
18
fish, yet horribly
inefficient for us (as
in the route of the
infamous recurrent
laryngeal nerve, which
takes a circuitous
path
from
the
brainstem down to the aorta and back up to the
larynx. Fish don’t have necks, it’s a direct shot for
them. Giraffe’s have it the worst: a 15ft detour.)
Even when we look at the molecular scale,
students still reach the same odd conclusion: that
because it’s complicated, it’s well designed. Yet, we
have cells that are often blind enough to let an
enemy (virus) into their house (cell membranes) and
use their kitchen to cook up a batch of 100,000 more
enemies. “Sure! Use my polymerases! You seem
trustworthy! Go on, date my daughter-I just
telophased her out yesterday!”
So, while this complicated epidermal bag of
electrolyte-rich fluid called a “human body” has a
mind-bogglingly complicated set-up, clearly it needs
some help (cue lights for healthcare team!).
I hope we continue to appreciate our heritage
in other mammals while progressing through our
medical education, and recognize that a complicated
system can be both as semi-dysfunctional and
beautiful, as we like to think it is. As such, I’ll add
a little twist to the traditional medical student
perspective: “Given the obvious blind watch making
of evolution, it’s also amazing that I may live to see
90+ years, largely thanks to medicine.” The human
body continues to amaze me in its complexity, but
also in the richness of its genetic heritage, and all the
quirky inefficiencies that came along for the ride.
19
MEMBERS
The Record: BCMA COMMUNITY
BCM A W ELCOMES NE W MEMBE R S :
William R. Alexis, MD
Interventional Cardiology
954.437.9116
Pembroke Pines
Man Q. Le, MD
Anesthesia
561.955.7246
Boca Raton
Richard J. Paley, MD
Emergency Medicine
954.415.4993
Deerfield Beach
Stuart Bernstsein, MD
Pulmonology
305.937.4400
Aventura
Ridwan Lin, MD
Neurology
954.786.5151
Deerfield Beach
Payal Patel, OMS
Medical Student
Nova Southeastern University
Valentina R. Bradley, MD
Dermatology
954.634.1595
Ft. Lauderdale
Alexander Llanos, MD
Cardiology/ Interventional
954.772.2136
Ft. Lauderdale
Shirley E.Campbell-Mogg, MD
Pediatrics
954.577.0321
Plantation
Basil Mangra, MD
Internal Medicine
954.484.6440
Lauderdale Lakes
Jose J. Diaz, DO
Physical Medicine+Rehabilitation
954.985.3932
Hollywood
Luis Mesa, MD
Pulmonology
305.937.4400
Aventura
Parham Eftekhari, DO
Nephrology
954.463.0112
Ft. Lauderdale
Baaz Mishiev, MD
Gastroenterology
954.961.8400
Hollywood
Alix Gay, MD
Internal Medicine/Geriatrics
954.927.0108
Hollywood
Ian J. Morales, MD
Internal Medicine/Pulmonary
305.978.7482
Plantation
Michael Halle, MD
Pediatrics
954.835.2111
Sunrise
Nils Mueller-Kronast, MD
Neurology/Neurointerventional
561.499.7551
Delray Beach
Karen Kennedy, DO
Hospice/Palliative Medicine
954.267.3800
Ft. Lauderdale
Alexandra Oleinik, OMS
Medical Student
Robin G. Schugar, MSPAS, PA-C
Assistant Professor
954.262.1281
Luis A. Orihuela, MD
Cardiovascular Disease
954.721.6666
Tamarac
Nandita Shankar, MD
Neurology/Neuromuscular Diseases
954.475.1735
Plantation
Lindsay La Corte, OMS IV
Medical Student
20
Samir Peshimam, MD
Critical Care Medicine (Intensivist)
954.265.9976
Hollywood
Lina Ramirez, MD
Pulmonology
305.937.4400
Aventura
Richard A. Reines, MD
Family Practice
954.987.7230
Hollywood
Mara R. Sanchez, MMS, PA-C
Assistant Professor
954.262.1261
Heidi Schaeffer, MD
Internal Medicine
786.303.9492
Pembroke Pines
Barry H. Schiff, MD
Cardiology
954.628.3802
Pembroke Pines
BCM A MEMO R I A M
BCMA extends their heartfelt sympathy to the families on their loss
Andrew C. Shatz, MD
Ophthalmology
954.653.0100
Sunrise
Stanley E. Skopit, DO
Dermatology
888.540.9660
Pompano Beach
Kenneth R. Stein, MD
Radiology
561.452.4110
Ft. Lauderdale
Peter P. Ventre, MD
Psychiatry
954.561.6222
Ft. Lauderdale
Bernd Wollschlaeger, MD
Family Practice
305.940.8717
N. Miami Beach
Luis M. Albuerne, MD
June 9, 2011
Howard J. Schlitt
July 4, 2011
Jeffrey Caron, MD
March 6, 2011
Marvin Harold Schultz, MD
September 27, 2011
Harold Conn, MD
October 9, 2011
Roger Schnell, MD
June 23, 2012
Jefferson R. Edwards, MD
July 23, 2011
Morton Nathan Schwartzman, MD
January 19, 2012
Harvey Keese, Jr., MD
January 30, 2012
Calvin Hylton Shirley, MD
June 23, 2012
Homer L. Marquit, MD
February 4, 2012
Janee Steinberg, MD
June 11, 2012
Bohdan Moroz, MD
July 24, 2011
Lawrence Stempel, DO
July 1, 2011
Guillermo Rodriguez, MD
December 13, 2011
Steven F. Woodring, DO
Anesthesiology
239.349.2604
Naples
Jacob W. Zeiders, MD
Pediatric Otolaryngology
954.888.8997
Ft. Lauderdale
21
2012 Inauguration Dinner
Kutty Chandran, MD
Amie Chandran, RN
Blanca Perper-Greenstein
Joshua Perper, MD
Carolyn Husband and Eddie Hernandez from MDinTouch
Payal Patel, OMS, NSU; Milla Kviatkovsky, OMS, NSU;
Gene Cash, Ph.D; and Dana Wallace, MD
Sangeetha Chandramohan, MD
Kirk Kreis, ProAssurance
22
Thea Burrell, Leena Moran from
BlueCross BlueShield of Florida
Mark Rosen, Esq. and Debby Rosen
Lubell & Rosen
Friends from BB&T Bank
Joni Routman, RN, President - FMA Allliance
and Kathy Molinet, ARNP,
Past President - FMA Alliance
Susan Flaten, RN; Mark Swerdloff, MD
and Gertrude Kloep
Milla Kaviatkovsky, Alex Oleinik, Payal Patel, Alice Lin and
Lena Virasch, Osteopathic medical students from NSU
Ashley Boxer Dailey, Jacqueline Cananles,
Marcus Suchecki, Pedro Fernandez, MD
from Baptist Health South Florida
23
Inauguration Dinner
Sunil Kumar, MD; Vandana Kumar, MD;
Peter Johnson, MD; Shirley Johnson, MD;
Alberto Casaretto, MD and Caren Singer, MD
Richard Steinman, MD and Mela Steinman
Alan Routman, MD;
Joni Routman, RN;
Pearl Goodman
and Stanley Goodman, MD
Stacy Frankel, MD
and Ralph Zagha, MD
2012
Tony Prieto, MD and Lynne Prieto
University of Miami
Hurricane Bhangra Dance Team
Talia Elkin, Gil Bronner, Michal Elkin,
Pinchas Elkin, Aaron Elkin, MD and Judy Elkin
24
“As physicians, we have so many
unknowns coming our way...
One thing I am certain about
is my malpractice protection.”
Medicine is feeling the eﬀects of regulatory
and legislative changes, increasing risk, and
profitability demands—all contributing to an
atmosphere of uncertainty and lack of control.
What we do control as physicians:
our choice of a liability partner.
I selected ProAssurance because they stand
behind my good medicine and understand my
business decisions. In spite of the maelstrom
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I believe in fair treatment—
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Proudly Endorsed by
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ProAssurance Group is rated A (Excellent) by A.M. Best.
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4 BROWARD
ProAssurance.com
• 800.222.5115

Summer 2012 - Broward County Medical Association

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